<form action="" class="form-horizontal" data-toggle="validator" id="add-form" method="POST" role="form">
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">姓名:</label>
        <div class="col-xs-12 col-sm-8">
            <input class="form-control" data-rule="required" name="row[cleaner_name]" placeholder="姓名"
                   type="text" value="">
        </div>
    </div>
<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">编码(校区)(中文):</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input class="form-control" data-rule="required" name="row[code]" placeholder="请输入编码(校区)"-->
<!--                   type="text" value="">-->
<!--        </div>-->
<!--    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">联系电话:</label>
        <div class="col-xs-12 col-sm-8">
            <input class="form-control" data-rule="required" name="row[phone]" placeholder="请输入联系电话"
                   type="text">
        </div>
    </div>
    <div class="form-group">
        <label for="c-title" class="control-label col-xs-12 col-sm-2">省市名称:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-title" class="form-control" data-toggle="city-picker" name="row[address]" data-level="district" type="text" value="" />
        </div>
    </div>
    <div class="form-group">

        <label for="" class="control-label col-xs-12 col-sm-2">小区地址</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control"  id="address" name="row[housing]" placeholder="地址" value="">
            <input type="text" class="form-control" name="row[lon]" id="lng" value="" placeholder="经度">
            <input type="text" class="form-control" name="row[lat]" id="lat" placeholder="纬度" value="">
            <button type="button" class="btn btn-primary" data-toggle='addresspicker' data-input-id="address" data-lng-id="lng" data-lat-id="lat">点击选择地址获取经纬度</button>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button class="btn btn-success btn-embossed " type="submit">{:__('OK')}</button>
            <button class="btn btn-default btn-embossed" type="reset">{:__('Reset')}</button>
        </div>
    </div>
</form>
